Reducing Peripheral Intravenous Catheter Use in Adult Acute Care: A Systematic Review

Peripheral intravenous catheters (PIVCs) are the most frequently inserted invasive device in acute care, yet up to 52% remain unused, exposing patients to avoidable risks and increasing healthcare costs. Despite growing awareness of inappropriate PIVC use, unnecessary insertion persists, driven by cultural and organisational norms and risk-averse practices. Interventions to reduce PIVC use have been implemented, but their effectiveness and sustainability have not been systematically synthesised. A systematic review was conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420251033201). Searches of CINAHL, MEDLINE, Scopus, and Web of Science identified studies reporting interventions to reduce PIVC insertion, unused PIVCs, and common complications. Data were extracted for intervention characteristics and PIVC outcomes. Implementation strategies were mapped to Consolidated Framework for Implementation Research domains for summative analysis. Random-effects meta-analysis was performed when appropriate. Twelve studies were included from emergency departments and inpatient settings across high-income countries. Most reported reductions in PIVC insertion and unused catheters, with improvements in secondary outcomes including phlebitis and bloodstream infections. Sustainability of practice change was demonstrated in two multi-year follow-up studies. Interventions showed a significant trend for increasing complexity over time, with recent strategies incorporating multi-modal, theory-informed approaches. Meta-analysis showed substantial heterogeneity, limiting pooled estimate interpretation, while methodological limitations restricted causal inference. Multi-modal interventions addressing behavioural, organisational, and contextual determinants appear most effective for reducing PIVC insertion rates and unnecessary PIVC use. Future research should evaluate sustainability, cost-effectiveness, and scalability using implementation science frameworks.